LOCATION OF DISPLAY: _______________________________________________________________________________ DATE OF DISPLAY: ___________________________________________________________________________________ TO: William Moody, Chief of Lincoln Bureau of Fire Prevention
The undersigned hereby makes application for a permit to conduct a public display of pyrotechnics before a proximate audience and agrees to comply with the City ordinances and regulations of the Bureau of Fire Prevention, and, hereby, declares that all the facts and representations stated in this application are true and correct. A $110 fee will be assessed.
ORGANIZATION SPONSORING DISPLAY: _________________________________________________________________ ADDRESS: ___________________________________________________________________________________
___________________________________________________________________________________
CITY STATE ZIP
DATE OF DISPLAY: ___________________________________________________________________________________ TIME OF DISPLAY: ___________________________________________________________________________________ LOCATION OF DISPLAY: _______________________________________________________________________________
• Attach a scale drawing locating the display site
• If the property is not owned by the Permittee, provide a copy of authorization to use the property PERSON IN CHARGE OF FIRING THE DISPLAY:
OPERATOR: __________________________________________________________________________________ ADDRESS: __________________________________________________________________________________ __________________________________________________________________________________
CITY STATE ZIP
TELEPHONE: ______________________________________________ AGE: ____________________________
Application for
PYROTECHNIC PROXIMATE AUDIENCE DISPLAY
PLEASE PRINT OR TYPE
Bureau of Fire Prevention – City of Lincoln
555 S 10
thSt. Rm 203 Lincoln, NE 68508-3995
Building & Safety Website
BUREAU OF FIRE PREVENTION POLICY
Public Liability Insurance and Bond Requirements
For
Pyrotechnic Display & Explosives Permits
Section 5601.2.4, 2012 Edition of the International Fire Code: The Permittee shall furnish a bond or certificate of insurance in the amount deemed adequate by the Chief for payment of damages which could be caused either to a person, persons, or to property by reason of the permitted display and arising from acts of the Permittee, agents, employees, or subcontractors.
Public Liability of Insurance
The Permittee shall maintain during the life of this contract, Public Liability Insurance, naming the City of Lincoln as an additional Insured against claims for damages resulting from (a) bodily injury, including wrongful death, and (b) property damage which may arise from operations from under this permit whether such operations be by himself/herself or by anyone directly or indirectly employed by him/her. The Permittee shall provide a certificate of insurance as evidence of coverage with the permit. The minimum acceptable limits of liability to be provided by such insurance shall be:
$2,000,000.00 Combined Single Limit Each Occurrence
If the Permittee is an employee or subcontractor of the Insured, the certificate of insurance shall extend coverage to its employees or contractors and the Permittee shall provide evidence of its employee or contractual relationship to the Insured when making application for a permit.
Name of Insured ___________________________________________________________________________________ Are you an employee or subcontractor of the Insured? ____________________________________________________ Does the insurance coverage extend to employees or subcontractors of the Insured? ____________________________
***Please provide evidence of your employee or contractual relationship by either a letter, on company letterhead,
from your employer or contractor indicating that you are an employee or subcontractor covered under their insurance policy or provide a certificate of insurance specifically naming you as an Insured. Please attach said evidence to the application.***
Bond Requirements
When the Chief determines that unusual or exceptional hazard exits, every applicant for a permit for a public display of fireworks shall file with the application, a bond in the sum of not less than five thousand dollars ($5,000.00) executed by a bonding company or surety company authorized to do business in the State of Nebraska, or in lieu of such a bond, the application may be accompanied with a certified check payable to he City of Lincoln, Nebraska, in the sum of five
GENERAL REQUIREMENTS FOR PROXIMATE
AUDIENCE PYROTECHNIC DISPLAYS
1. Storage: Storage of all pyrotechnic materials shall be in accordance with NFPA 1126, Use of Pyrotechnics Before a
Proximate Audience.
2. Pyrotechnics Plans: Before the performance of any production the applicant shall submit a plan for the use of
pyrotechnics to the Bureau of Fire Prevention. After a permit has been granted, the Permittee shall keep the plan available at the site for safety inspections by the Bureau of Fire Prevention.
• Any additions to the pyrotechnic performance must be approved by the Chief of the Bureau of Fire Prevention.
3. Fire Extinguishers: Two or more fire extinguishers and proper classification and size as approved by the Bureau of
Fire Prevention shall be readily accessible while the pyrotechnics are being loaded and prepared for firing or fired. • Personnel shall have a working knowledge of the use of fire extinguishers. Fire extinguishers shall be present
while the pyrotechnics are being handled, used, or removed.
4. Separation Distance for Audience: Each pyrotechnic device fired during a performance shall be separated from the
audience by at least fifteen (15) feet but not less than twice the fall out radius of the device. Concussion mortars shall be separated from the audience by a minimum of twenty-five (25) feet. There shall be no glowing or flaming particles within ten (10) feet of the audience.
5. Age Requirements: All pyrotechnic operators shall be at least 21 years old. Assistants shall be at least 18 years old.
Safety Precautions
1. Pyrotechnic materials and devices shall be maintained in a neat and orderly condition and shall be kept free of any conditions that can create a fire hazard.
2. Pyrotechnic materials and devices shall be stored in accordance with the regulations promulgated by the Bureau of Alcohol, Tobacco, and Firearms (ATF).
3. No quantity of pyrotechnics greater than that needed for the production of the special effects in the performance or rehearsal shall be removed from storage.
4. Smoking shall not be permitted within twenty-five (25) feet of the area where pyrotechnics are being handled or fired.
PERSON(S), IF ANY, ASSISTING THE OPERATOR:
__________________________________________________________________________________________________
NAME ADDRESS AGE
__________________________________________________________________________________________________
NAME ADDRESS AGE
WILL ADEQUATE FIRE PROTECTION BE PROVIDED? _________________________________________________________ BY WHOM? ________________________________________________________________________________________ WHAT CROWD CONTROL PROCEDURES WILL BE USED? _____________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ WHAT WILL BE OPERATOR’S SOURCE OF ILLUMINATION? ___________________________________________________ __________________________________________________________________________________________________ WHAT WILL BE THE MANNER & PLACE OF PYROTECHNIC MATERIALS STORAGE PRIOR TO DISPLAY?
__________________________________________________________________________________________________ PYROTECHNICS TO BE USED:
KIND: _______________________________________________________________ QUANTITY: ____________________ KIND: _______________________________________________________________ QUANTITY: ____________________ KIND: _______________________________________________________________QUANTITY: ____________________ HAS A DIAGRAM BEEN ATTACHED? ___________________________
THE REQUIRED BOND FOR THE PYROTECHNICS DISPLAY IS IN THE AMOUNT OF: _________________________________ NAME OF THE SURETY COMPANY EXECUTING THE BOND: ___________________________________________________ AMOUNT: ____________________________________ TERM: _______________________________________________ NAME OF THE PUBLIC LIABILITY INSURANCE CARRIER: ______________________________________________________ LIMITS:
The Permittee shall indemnify and save harmless the City of Lincoln, Nebraska from and against all losses, claims, damages, and expenses, including attorney’s fees, arising out of or resulting from the exercise of privileges granted under this permit that results in bodily injury, sickness, disease, death, or to injury to or destruction of tangible property, including the loss of use resulting there from and is caused in whole – or in part by the Permittee, its agents, or anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable.
Permittee shall not exercise any of the privileges granted by this permit until he/she has obtained all required insurance and bonds and such insurance and bonds have been approved by the City Attorney for the City of Lincoln.
_________________________________________________________________ Signature of Permittee or Authorized Representative
APPROVED: ___________________________________________ Chief, Bureau of Fire Prevention
INSPECTION BY: _______________________________________ DATE: _______________________________________________ FEE PAID ($110): ______________________________________
